Hepatitis C is a virus that infects
the liver. It is spread by contact with infected blood, for instance by
using contaminated needles for injecting drugs or sharing razors or
toothbrushes. The virus can cause inflammation of, and damage to, the
liver, preventing it from working properly.
About a third of people infected with the hepatitis
C virus will eventually develop liver cirrhosis, where normal liver
tissue is replaced by scar tissue. A small number of people with chronic
hepatitis C and cirrhosis also go on to develop liver cancer.
The aims of treatment are to
clear the virus from the blood to prevent progression of liver disease,
and to prevent the transmission of the hepatitis C virus. Sofosbuvir and
simeprevir are oral antiviral drugs used to prevent hepatitis C viral
replication in infected cells.
Sofosbuvir has a marketing
authorisation in the UK for use in combination with other medicinal
products for treating chronic hepatitis C in adults. The guidance on
sofosbuvir recommends its use in combination with ribavirin, with or
without peginterferon alfa, as an option for some people with genotypes
1- 6 chronic hepatitis C.
Simprevir has a marketing authorisation in
the UK for use in combination with other medicinal products for
treating adults with genotype 1 or 4 chronic hepatitis C. The guidance
on simeprevir recommends its use, in combination with peginterferon alfa
and ribavirin, as an option for treating both genotypes 1 and 4 chronic
hepatitis C in adults.
More data on the use of simeprevir in
combination with sofosbuvir to treat chronic hepatitis C in people who
can’t tolerate or aren’t eligible for treatment with interferon is due
to become available soon. Therefore recommendations on this treatment
combination will now be developed in separate guidance.
Commenting on today’s guidance Professor Carole Longson, Director of the NICE Centre for Health Technology Evaluation, said: “Poor
diagnosis rates - estimates suggest around 50% of people with the
condition in England remain undiagnosed - combined with a high number of
new infections annually make hepatitis C a major public health
challenge. But even when people are diagnosed, the long duration and
potentially unpleasant side-effects of current interferon-based
treatments can discourage people with the disease from completing the
full course, or even from seeking treatment in the first place.
“New treatments, like sofosbuvir and simeprevir,
can shorten the length of interferon-based therapy and in some
situations don’t need to be taken with interferon at all. Both drugs can
also be given to people who have previously been treated but did not
clear the virus, in people whose condition has relapsed, or in people
who have become re-infected after treatment.
“Sofosbuvir and simeprevir could therefore be
valuable treatment options for people with chronic hepatitis C. This is
good news, not just for people with chronic hepatitis C, but also
because having more effective treatments for the condition could reduce
the spread of the virus.”